Insertion of Transvenous Endocardial Pacemaker
Objective
In cases of heart block:
• Placing of an electrode lead in the endocardium through the cephalic, subclavian, or jugular vein and attaching the lead to a pulse generator.
Position
Supine.
Anesthesia
Local.
Procedure
1. Cut down is performed to expose the subclavian, cephalic or external jugular vein.
2. A ventomy, a pacing electrode is inserted and advanced into the right ventricle.
3. The electrode is attached to an external pacemaker for testing.
4. An incision is made in the chest wall and deepened down to the fascia, creating a “pocket’ for the pulse generator.
5. The pulse generator is placed in the pocket.
6. Both incisions may be irrigated with a antibiotic solution and closed.
Instruments
• Pacemaker tray
• Hemoclip appliers (small and medium)
• Basin set
• Blades (2) No. 10, (1) No. 15, (1) No. 11
• Vessel loops
• Local syringe and needle
• Antibiotic irrigation and bulb syringe.
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